<h1 class="page-title"><?php echo $this->translate($this->title); ?></h1>
<div class="fieldset">
    <form id="register" method="post">
    <?php if(isset($this->data['id'])): ?>
    <input type="hidden" name="id" value="<?php echo $this->data['id']; ?>" />
    <?php endif; ?>
    <h2 class="legend"><?php echo $this->translate('personal information'); ?></h2>
	<ul class="form-list">
		<li class="fields">
			<div class="customer-name">
				<div class="input-box name-firstname">
					<label for="firstname"><?php echo $this->translate('name'); ?><em>*</em></label>
					<input type="text" class="required-entry input-text" title="name" value="<?php echo $this->data['name']; ?>" name="name" id="name">
                    <?php if(isset($this->error['name']) && $this->error['name'] != ""): ?>
                    <label for="lastname"><em><?php echo $this->error['name']; ?></em></label>
                    <?php endif; ?>
				</div>
				<div class="input-box name-lastname">
					<label for="lastname"><?php echo $this->translate('address'); ?></label>
					<input type="text" class="required-entry input-text" title="<?php echo $this->translate('address'); ?>" value="<?php echo $this->data['address']; ?>" name="address" id="address">
				</div>
				<div class="clear"></div>
            </div>                
        </li>
        <li class="fields">
			<div class="customer-name">
				<div class="input-box name-firstname">
					<label for="firstname"><?php echo $this->translate('phone number'); ?><em>*</em></label>
					<input type="text" class="required-entry input-text" title="<?php echo $this->translate('phone number'); ?>" value="<?php echo $this->data['phone_number']; ?>" name="phone_number" id="phone_number">
                    <?php if(isset($this->error['phone_number']) && $this->error['phone_number'] != ""): ?>
                    <label for="lastname"><em><?php echo $this->error['phone_number']; ?></em></label>
                    <?php endif; ?>
				</div>
				<div class="input-box name-lastname">
					<label for="lastname"><?php echo $this->translate('email'); ?><em>*</em></label>
					<input <?php if(isset($this->edit) && $this->edit == true) echo 'disabled="disabled"'; ?> type="text" class="required-entry input-text" title="<?php echo $this->translate('email'); ?>" value="<?php echo $this->data['email']; ?>" name="email" id="email">
                    <?php if(isset($this->error['email']) && $this->error['email'] != ""): ?>
                    <label for="lastname"><em><?php echo $this->error['email']; ?></em></label>
                    <?php endif; ?>
				</div>
				<div class="clear"></div>
            </div>                
        </li>
	</ul>
	<h2 class="legend"><?php echo $this->translate('account information'); ?></h2>
	<ul class="form-list">
        <li class="fields">
            <div class="customer-name">
				<div class="input-box name-firstname">
					<label for="firstname"><?php echo $this->translate('username'); ?><em>*</em></label>
					<input <?php if(isset($this->edit) && $this->edit == true) echo 'disabled="disabled"'; ?> type="text" class="required-entry input-text" title="<?php echo $this->translate('username'); ?>" value="<?php echo $this->data['username']; ?>" name="username" id="firstname">
                    <?php if(isset($this->error['username']) && $this->error['username'] != ""): ?>
                    <label for="lastname"><em><?php echo $this->error['username']; ?></em></label>
                    <?php endif; ?>
				</div>
			</div>
        </li>
		<li class="fields">
			<div class="customer-name">
				<div class="input-box name-firstname">
					<label for="firstname"><?php echo $this->translate('password'); ?><em>*</em></label>
					<input type="password" class="required-entry input-text" title="<?php echo $this->translate('password'); ?>" value="" name="password" id="firstname">
                    <?php if(isset($this->error['password']) && $this->error['password'] != ""): ?>
                    <label for="lastname"><em><?php echo $this->error['password']; ?></em></label>
                    <?php endif; ?>
				</div>
				<div class="input-box name-lastname">
					<label for="lastname"><?php echo $this->translate('repassword'); ?><em>*</em></label>
					<input type="password" class="required-entry input-text" title="<?php echo $this->translate('repassword'); ?>" value="" name="repassword" id="lastname">
                    <?php if(isset($this->error['repassword']) && $this->error['repassword'] != ""): ?>
                    <label for="lastname"><em><?php echo $this->error['repassword']; ?></em></label>
                    <?php endif; ?>
				</div>
				<div class="clear"></div>
			</div>
		</li>
	</ul>
	<div class="buttons-set">
		<p class="required">* <?php echo $this->translate('required'); ?></p>
		<a href="account_login.html" title="Back" class="f-left">&laquo; Back</a>
		<a onclick="register()" title="<?php echo $this->translate('submit'); ?>" class="colors-btn"><span><span><?php echo $this->translate('submit'); ?></span></span></a>
		<div class="clear"></div>
	</div>
    </form>
</div>
<script>
function register(){
    $("form#register").submit();
    
    return false;
}
</script>